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Some of my most wonderful memories of childhood
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are of spending time with my grandmother, Mamar [???],
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in our four-family home in Brooklyn, New York.
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Her apartment was an oasis.
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It was a place where I could sneak a cup of coffee,
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which was really warm milk
with just a touch of caffeine.
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She loved life.
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And although she worked in a factory,
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she saved her pennies and she traveled to Europe.
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And I remember poring over those pictures with her
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and then dancing with her to her favorite music.
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And then, when I was eight and she was sixty,
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something changed.
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She no longer worked or traveled.
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She no longer danced.
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There were no more coffee times.
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My mother missed work and took her to doctors
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who couldn't make a diagnosis.
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And my father, who worked at night,
would spend every afternoon with her --
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just to make sure she ate.
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Her care became all-consuming for our family.
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And by the time a diagnosis was made,
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she was in a deep spiral.
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Now many of you will recognize her symptoms.
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My grandmother had depression.
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A deep, life-altering depression,
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from which she never recovered.
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And back then, so little was known about depression.
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But even today, 50 years later,
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there's still so much more to learn.
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Today, we know women are 70 percent more likely
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to experience depression over their lifetimes
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compared with men.
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And even with this high prevalence,
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women are misdiagnosed between
30 and 50 percent of the time.
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Now we know that women are more likely
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to experience the symptoms
of fatigue, sleep disturbance,
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pain and anxiety compared with men.
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And these symptoms are often overlooked
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as symptoms of depression.
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And it isn't only depression in which
these sex differences occur,
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but they occur across so many diseases.
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So it's my grandmother's struggles
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that have really led me on a lifelong quest.
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And today, I lead a center in which the mission
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is to discover why these sex differences occur
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and to use that knowledge
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to improve the health of women.
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Today, we know that every cell has a sex.
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Now, that's a term coined by the Institute of Medicine.
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And what it means is that
men and women are different
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down to the cellular and molecular levels.
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It means that we're different
across all of our organs.
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From our brains to our hearts, our lungs, our joints.
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Now, it was only 20 years ago that we
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hardly had any data on women's health
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beyond our reproductive functions.
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But then in 1993,
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the NIH Revitalization Act was signed into law.
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And what this law did was it mandated
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that women and minorities be included in clinical trials
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that were funded by the National Institutes of Health.
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And in many ways, the law has worked.
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Women are now routinely included in clinical studies,
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and we've learned that there are major differences
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in the ways that women and men
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experience disease.
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But remarkably,
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what we have learned about these
differences is often overlooked.
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So, we have to ask ourselves the question:
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Why leave women's health to chance?
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And we're leaving it to chance in two ways.
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The first is that there is so much more to learn
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and we're not making the investment
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in fully understanding the extent
of these sex differences.
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And the second is that we aren't
taking what we have learned,
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and routinely applying it in clinical care.
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We are just not doing enough.
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So, I'm going to share with you three examples
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of where sex differences have
impacted the health of women,
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and where we need to do more.
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Let's start with heart disease.
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It's the number one killer of women
in the United States today.
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This is the face of heart disease.
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Linda is a middle-aged woman,
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who had a stent placed in one of the arteries
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going to her heart.
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When she had recurring symptoms
she went back to her doctor.
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Her doctor did the gold-standard test --
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a cardiac catheterization.
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It showed no blockages.
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Linda's symptoms continued.
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She had to stop working.
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And that's when she found us.
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When Lynda came to us, we did
another cardiac catheterization
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and this time, we found clues.
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But we needed another test
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to make the diagnosis.
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So we did a test called an intracoronary ultrasound,
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where you use soundwaves to look at the artery
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from the inside out.
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And what we found
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was that Linda's disease didn't look like
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the typical male disease.
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The typical male disease looks like this.
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There's a discrete blockage or stenosis.
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Linda's disease, like the disease of so many women,
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looks like this.
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The plaque is laid down more evenly, more diffusely
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along the artery, and it's harder to see.
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So for Linda, and for so many women,
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the gold-standard test wasn't gold.
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Now, Lynda received the right treatment.
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She went back to her life and fortunately, today
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she is doing well.
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But Lynda was lucky.
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She found us, we found her disease.
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But for too many women, that's not the case.
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We have the tools.
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We have the technology to make the diagnosis.
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But it's all too often that these sex diffferences
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are overlooked.
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So what about treatment?
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A landmark study that was published two years ago
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asked the very important question:
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What are the most effective treatments
for heart disease in women?
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The authors looked at papers
written over a 10-year period,
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and hundreds had to be thrown out.
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And what they found out was that
of those that were tossed out,
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65 percent were excluded
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because even though women
were included in the studies,
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the analysis didn't differentiate
between women and men.
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What a lost opportunity.
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The money had been spent
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and we didn't learn how women fared --
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and these studies could not contribute one iota
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to the very, very important question:
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What are the most effective treatments
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for heart disease in women?
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I want to introduce you to
Hortense [???], my godmother,
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Hung Way [???], a relative of a colleague,
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and somebody you may recognize --
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Dana, Christopher Reeve's wife.
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All three women have something
very important in common.
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All three were diagnosed with lung cancer,
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the number one cancer killer of women
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in the United States today.
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All three were non-smokers.
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Sadly, Dana and Hung Way [???] died of their disease.
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Today, what we know is that women who are
non-smokers are three times more likely
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to be diagnosed with lung cancer than are men
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who are non-smokers.
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Now interestingly, when women are
diagnosed with lung cancer,
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their survival tends to be better than that of men.
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Now here are some clues.
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Our investigators have found that there are
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certain genes in the lung tumor
cells of both women and men.
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And these genes are activated
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mainly by estrogen.
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And when these genes are over-expressed,
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it's associated with improved survival
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only in young women.
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Now this is a very early finding
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and we don't yet know whether it has relevance
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to clinical care.
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But it's findings like this that may provide hope
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and may provide an opportunity to save lives
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of both women and men.
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Now let me share with you an example
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of when we do consider sex differences,
it can drive the science.
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Several years ago a new lung cancer drug
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was being evaluated,
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and when the authors looked at whose tumors shrank,
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they found that 82 percent were women.
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This led them to ask the question: Well, why?
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And what they found
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was that the genetic mutations that the drug targeted
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were far more common in women.
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And what this has led to
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is a more personalized approach
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to the treatment of lung cancer
that also includes sex.
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This is what we can accomplish
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when we don't leave women's health to chance.
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We know that when you invest in research,
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you get results.
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Take a look at the death rate from breast cancer over time.
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And now take a look at the death rates
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from lung cancer in women over time.
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Now let's look at the dollars invested in breast cancer --
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these are the dollars invested per death --
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and the dollars invested in lung cancer.
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Now it's clear that our investment in breast cancer
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has produced results.
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They may not be fast enough,
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but it has produced results.
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We can do the same
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for lung cancer and for every other disease.
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So let's go back to depression.
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Depression is the number-one cause
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of disability in women in the world today.
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Our investigators have found
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that there are differences in the brains
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of women and men
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in the areas that are connected with mood.
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And when you put men and women
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in a functional MRI scanner --
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that's the kind of scanner that shows how the brain is functioning when it's activated --
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so you put them in the scanner
and you expose them to stress.
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You can actually see the difference.
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And it's findings like this
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that we believe holds some of the clues
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for why we see these very significant sex differences
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in depression.
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But even though we know
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that these differences occur,
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66 percent
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of the brain research that begins in animals
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is done in either male animals
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or animals in whom the sex is not identified.
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So, I think we have to ask again the question:
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Why leave women's health to chance?
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And this is a question that haunts those of us
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in science and medicine
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who believe that we are on the verge
of being able to dramatically improve
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the health of women.
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We know that every cell has a sex.
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We know that these differences are often overlooked.
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And therefore we know that women
are not getting the full benefit
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of modern science and medicine today.
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We have the tools
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but we lack the collective will and momentum.
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Women's health is an equal rights issue
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as important as equal pay.
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And it's an issue of the quality
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and the integrity of science and medicine.
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(Applause)
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So imagine the momentum we could achieve
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in advancing the health of women
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if we considered whether these
sex differences were present
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at the very beginning of designing research.
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Or if we analyzed our data by sex.
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So, people often ask me:
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What can I do?
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And here's what I suggest:
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First, I suggest that you think about women's health
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in the same way
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that you think and care about other
causes that are important to you.
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And second, and equally as important,
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that as a woman,
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you have to ask your doctor
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and the doctors who are caring
for those who you love:
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Is this disease or treatment different in women?
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Now this is a profound question
because the answer is likely yes --
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but your doctor may not know
the answer, at least not yet.
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But if you ask the question,
your doctor will very likely
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go looking for the answer.
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And this is so important --
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not only for ourselves,
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but for all of those whom we love.
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Whether it be a mother, a daughter, a sister,
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a friend or a grandmother.
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It was my grandmother's suffering
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that inspired my work
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to improve the health of women.
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That's her legacy.
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Our legacy can be to improve the health of women
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for this generation
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and for generations to come.
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Thank you.
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(Applause)